Hubungan Ketahanan Pangan, Status Sosial Ekonomi Miskin dan Tidak Miskin, serta Mikrobiota Mulut Ibu Hamil dengan Outcome Kehamilan

Abstract

Ketahanan pangan rumah tangga merupakan faktor mendasar dalam pemenuhan gizi ibu hamil. Rumah tangga dengan ketahanan pangan rendah sering memiliki pola konsumsi dengan jumlah terbatas dan kurang beragam, sehingga meningkatkan risiko kekurangan zat gizi dan outcome kehamilan yang merugikan. Kondisi ini diperberat oleh status sosial ekonomi yang menentukan kemampuan keluarga memperoleh pangan bergizi. Selain faktor gizi, mikrobiota mulut juga berperan dalam mekanisme inflamasi selama kehamilan. Perubahan hormonal dan imunologis dapat menyebabkan disbiosis, meningkatkan risiko penyakit periodontal yang dikaitkan dengan berat badan lahir rendah (BBLR), panjang badan lahir pendek, preeklamsia, dan kelahiran prematur. Namun, penelitian yang mengintegrasikan ketahanan pangan, sosial ekonomi, mikrobiota mulut dan outcome kehamilan dalam satu model analitik masih terbatas, khususnya di Indonesia. Penelitian ini bertujuan menganalisis perbedaan ketahanan pangan, kondisi sosial ekonomi, dan outcome kehamilan antara Gakin dan Non-Gakin. Selain itu penelitian ini menilai hubungan ketahanan pangan dengan outcome kehamilan, mengevaluasi perbedaan mikrobiota mulut, serta menilai hubungan mikrobiota mulut dengan ketahanan pangan dan outcome kehamilan. Desain penelitian menggunakan kohort prospektif pada ibu hamil trimester II – III di Kota Yogyakarta (Agustus 2024 – Februari 2025). Sebanyak 120 ibu hamil dianalisis untuk variabel utama, dan 12 ibu diikutsertakan sebagai subsampel untuk analisis mikrobiota menggunakan metode 16S rRNA. Data dikumpulkan melalui wawancara, pengukuran, pemeriksaan periodontal, serta tindak lanjut hingga persalinan. Penelitian ini diharapkan memperkuat bukti ilmiah mengenai peran ketahanan pangan dan sosial ekonomi terhadap outcome kehamilan dengan mempertimbangkan mikrobiota mulut sebagai komponen biologis penting. Temuan diharapkan mendukung perumusan kebijakan lintas sektor dalam meningkatkan kesehatan ibu dan bayi. Hasil penelitian menunjukkan adanya kesenjangan sosial ekonomi yang nyata antara Gakin dan Non-Gakin, terutama pada umur, pendidikan, pekerjaan, pendapatan, dan pengeluaran. Adapun karakteristik obstetri ibu meliputi paritas, jarak kehamilan IMT pra hamil relatif serupa, hanya variabel umur ibu hamil yang berbeda signifikan. Usia kelompok Gakin secara signifikan lebih muda dibandingkan kelompok Non-Gakin. Kelompok Gakin mengalami kerawanan pangan yang secara signifikan lebih tinggi dibandingkan kelompok Non-Gakin. Frekuensi konsumsi jajanan manis dan asin secara signifikan lebih tinggi pada kelompok Gakin, sedangkan sebagian besar kelompok pangan lain serta asupan energi dan zat gizi tidak berbeda signifikan antara kedua kelompok. Keragaman pangan ibu hamil secara signifikan lebih rendah pada kelompok Gakin dibandingkan kelompok Non-Gakin. Outcome kehamilan, termasuk panjang badan lahir pendek, BBLR, komplikasi maternal, dan kelahiran prematur, tidak menunjukkan perbedaan yang bermakna antara kelompok Gakin dan Non-Gakin. Namun, terdapat kecenderungan proporsi panjang badan lahir pendek yang lebih tinggi pada kelompok Gakin. Paritas = 2 merupakan faktor protektif yang signifikan terhadap kelahiran prematur pada kedua kelompok sosial ekonomi, dengan efek yang lebih kuat pada kelompok Gakin. Faktor maternal lain, termasuk umur ibu dan status gizi pra-hamil, menunjukkan kecenderungan arah risiko tetapi belum signifikan secara statistik. Status ketahanan pangan rumah tangga tidak berhubungan secara signifikan dengan panjang badan lahir pendek maupun berat badan lahir rendah pada kedua kelompok sosial ekonomi. Meskipun arah estimasi risiko menunjukkan kecenderungan peningkatan pada rumah tangga rawan pangan, hubungan tersebut tidak mencapai signifikansi statistik. Analisis mikrobiota mulut menunjukkan bahwa komunitas inti relatif serupa antar kelompok, namun terdapat perbedaan ekologis pada tingkat komposisi. Kelompok Gakin cenderung didominasi genus anaerob inflamogenik seperti Prevotella, Veillonella, dan Fusobacterium, sedangkan kelompok Non-Gakin lebih banyak didominasi genus komensal protektif seperti Rothia, Corynebacterium, dan Actinomyces. Status ketahanan pangan rumah tangga pada sub-sampel ibu hamil (n=12) berhubungan dengan komposisi mikrobiota mulut. Rothia lebih dominan pada rumah tangga tahan pangan, sedangkan Prevotella meningkat seiring bertambahnya tingkat kerawanan pangan. Pola konsumsi antara kedua kelompok menunjukkan perbedaan. Kelompok gakin lebih sering mengonsumsi jajanan manis dan gula/pemanis, serta lebih jarang mengonsumsi buah. Sementara itu, konsumsi serealia, sayuran, dan pangan hewani relatif serupa. Hubungan antara mikrobiota mulut dengan outcome kehamilan, khususnya berat badan lahir dan panjang badan lahir, tidak menunjukkan hubungan yang signifikan secara statistik, namun arah asosiasi yang konsisten secara biologis mengindikasikan potensi peran mikrobiota mulut dalam pertumbuhan janin. Simpulannya, ketahanan pangan dan status sosial ekonomi masih menjadi determinan penting kesehatan ibu hamil, serta berpotensi memengaruhi profil mikrobiota mulut. Integrasi ketahanan pangan, skrining periodontal, dan pemantauan kesehatan maternal dalam layanan antenatal berpotensi sebagai strategi penting untuk meningkatkan outcome kehamilan.

Kata kunci: ibu hamil, ketahanan pangan, mikrobiota mulut, outcome kehamilan, status sosial ekonomi

Household food security is a fundamental determinant of adequate maternal nutrition during pregnancy. Households with low food security often have limited and less diverse dietary patterns, thereby increasing the risk of nutrient deficiencies and adverse pregnancy outcomes. This condition is further shaped by socioeconomic status, which determines a household’s capacity to access safe and nutritious foods. Beyond nutritional factors, the oral microbiota also plays a role in inflammatory mechanisms during pregnancy. Hormonal and immunological changes may induce oral dysbiosis, increasing the risk of periodontal disease, which has been associated with low birth weight (LBW), short birth length, preeclampsia, and preterm birth. However, studies integrating household food security, socioeconomic status, oral microbiota, and pregnancy outcomes within a single analytical framework remain limited, particularly in Indonesia. This study aimed to analyze differences in household food security, socioeconomic conditions, and pregnancy outcomes between low-income (Poor) and non–low-income (Non-Poor) pregnant women. In addition, the study assessed the association between household food security and pregnancy outcomes, evaluated differences in oral microbiota composition, and examined the relationship between oral microbiota, food security, and pregnancy outcomes. A prospective cohort design was conducted among pregnant women in their second and third trimesters in Yogyakarta City from August 2024 to February 2025. A total of 120 pregnant women were included for the main analyses, and 12 women were selected as a subsample for oral microbiota analysis using 16S rRNA sequencing. Data were collected through interviews, anthropometric measurements, periodontal examinations, and follow-up until delivery. The results indicate a pronounced socioeconomic disparity between the Poor and the Non-Poor groups, particularly with respect to maternal age, education, occupation, income, and household expenditure. Baseline maternal characteristics, including parity, interpregnancy interval, and pre-pregnancy body mass index, were relatively similar between groups; however, maternal age differed significantly, with women in the Poor group being significantly younger than those in the Non-Poor group. The Poor group experienced a significantly higher level of household food insecurity compared with the Non-Poor group. The frequency of consumption of sweet and salty snacks was significantly higher among the Poor group, whereas most other food groups as well as energy and nutrient intakes did not differ significantly between groups. Dietary diversity among pregnant women was significantly lower in the Poor group than in the Non-Poor group. Pregnancy outcomes including short birth length, low birth weight, maternal complications, and preterm birth did not differ significantly between Poor and Non-Poor groups. Nevertheless, a higher proportion of short birth length was observed among the Poor group. Parity of two or more births was a significant protective factor against preterm birth in both socioeconomic groups, with a stronger effect observed among Poor women. Other maternal factors, including maternal age and pre-pregnancy nutritional status, showed consistent risk directions but did not reach statistical significance. Household food security status was not significantly associated with short birth length or low birth weight in either socioeconomic group. Although risk estimates suggested a tendency toward increased risk among food-insecure households, these associations did not achieve statistical significance. Analysis of the oral microbiota showed that the core microbial community was relatively similar between groups; however, ecological differences were observed at the compositional level. The Poor group tended to be dominated by anaerobic, inflammogenic genera such as Prevotella, Veillonella, and Fusobacterium, whereas the Non-Poor group was more frequently dominated by protective commensal genera, including Rothia, Corynebacterium, and Actinomyces. Household food security status in a subsample of pregnant women (n=12) was associated with oral microbiota composition, with Rothia being more dominant in food-secure households and Prevotella increasing with greater levels of food insecurity. Dietary patterns differed between the two groups, with the Poor group consuming sweet snacks and sugar/sweeteners more frequently and fruit less frequently. In contrast, the consumption of cereals, vegetables, and animal-source foods was relatively similar between groups. In conclusion, household food security and socioeconomic status remain important determinants of maternal health and may influence oral microbiota profiles during pregnancy. The integration of food security assessment, periodontal screening, and maternal health monitoring into antenatal care services could serve as an important strategy to improve pregnancy outcomes. Keywords: household food security, oral microbiota, pregnancy outcomes, pregnant women, socioeconomic status